摘要
目的研究过敏性紫癜(HSP)患儿血清免疫球蛋白1免疫复合物(IgA1-IC)对中性粒细胞激活的影响,探讨HSP微血管损伤的病因以及紫癜性肾炎(HSPN)的发病机制。方法选取2016年8月—2017年8月在兰州大学第一医院收治入院的初诊HSP患儿,4周内未接受激素治疗,同时排外患风湿免疫系统疾病、过敏性疾病或其他肾脏疾病。对照组为60例非感染因素入院,并排外自身免疫性疾病,且无肾脏器质性病变者。所有入选对象均在入院当日收集血样,酶联免疫吸附法测定血清IgA1-IC、髓过氧化物酶(MPO)和弹性蛋白酶(NE)的质量浓度,血液常规分析获得白细胞及中性粒细胞计数,流式细胞术检测IgA Fc受体(CD89+)百分比,实时荧光定量多聚核苷酸链式反应法检测CD89mRNA的表达量。为观察HSPN的发病情况,在数据统计阶段依据有无肾脏受累分为HSP组(76例)和HSPN组(32例)。结果HSP组血清中IgA1-IC、MPO、NE质量浓度与对照组相比均明显升高(P<0.05);HSPN组IgA1-IC质量浓度高于HSP组(P<0.05);MPO、NE质量浓度在HSPN组与HSP组之间的差异无统计学意义。HSP组与对照组比较,白细胞计数、中性粒细胞绝对值、CD89+百分比均明显升高,差异有统计学意义;HSPN组白细胞计数、中性粒细胞绝对值、CD89+百分比均高于HSP组;在mRNA水平上,HSP组CD89 mRNA的表达明显高于对照组(P<0.05),但HSPN组患儿CD89 mRNA表达量与HSP组、对照组之间的差异无统计学意义(P>0.05)。Person相关分析结果显示,HSPN组IgA1-IC与NE质量浓度呈正相关关系(r=0.454,P<0.009),MPO和IgA1-IC质量浓度在总体趋势上有一致性,但相关性不显著(r=0.277,P<0.125)。结论HSP患儿IgA1-IC质量浓度明显升高,与CD89结合激活中性粒细胞,致使中性粒细胞释放MPO及弹性蛋白酶损伤血管内皮细胞,在HSP发病过程中发挥重要作用;HSPN的发病与中性粒细胞的过度活化有关,同时受到个体差异的影响。
Objective To research into the relationship between IgA1 immune complex(IgA1-IC)and the activation of neutrophils(Neu),study the effects of serum IgA1-IC on neutrophil Neu activation in children with Henoch-Schonlein purpura(HSP),explore the etiology of HSP microvascular damage,and to prelimi-nary explore the pathogenesis of Henoch-Schonlein purpuric nephritis(HSPN).Methods This study selected children with HSP who first visited The First Hospital of Lanzhou University from August 2016 to August 2017,not receiving hormonal treatment within 4 weeks and also suffering from rheumatic immune system diseases,allergic diseases or other kidney diseases.At the same time,60 children with non-infectious factors were collected as the control group,who were without nephritis organic diseases.Blood samples were collected on the day of admission.Determination of IgA1-IC,myeloperoxidase(MPO)and elastase(NE)was carried out by enzyme-linked immunosorbent assay,the percentage of neutrophils CD89+was detected flow cytometry and the expression of CD89 mRNA by real-time PCR.Leukocyte and neutrophil counts were obtained by routine blood analysis.In order to observe the incidence of HSPN,the patients were divided into an HSP group(76 cases)and HSPN group(32 cases)according to the presence or absence of renal involvement.Results In comparison with the control group,the levels of IgA1-IC,MPO and NE were significantly higher(P<0.05);the levels of IgA1-IC in the HSPN group was higher than that in the HSP group(P<0.05),there was no significant difference in the level of HSPN compared with the HSP group with MPO,NE(P<0.05).Compared with the control group,leukocyte,neutrophil and the percentage of neutrophil CD89+increased significantly in HSP group(P<0.05).Leukocyte,neutrophil and the percentage of CD89+in HSPN group were significantly higher than those in the HSP group(P<0.05).The expression of CD89 mRNA in the HSP group was significantly higher than that in the control group(P<0.05).But there was no significant difference between the HSPN group and HSP group and control group(P>0.05).A person correlation analysis results showed that IgA1-IC was positively correlated with NE level in the HSPN group(r=0.454,P<0.009),and MPO and IgA1-IC levels were consistent in the overall trend,but the correlation was not significant(r=0.277,P<0.125).Conclusion The level of IgA1-IC in children with HSP was significantly increased,through the combination of CD89 on the surface of neutrophils(Neu)and excessive activation of Neu,thus playing an important role in the pathogenesis of HSP.The onset of HSPN was associated with excessive activation of Neu,and affected by individual differences.
作者
郭婷
李宇宁
凌继祖
Guo Ting;Li Yu-ning;Ling Ji-zu(Department of Pediatrics,The First Hospital of Lanzhou University,Lanzhou 730000,China)
出处
《兰州大学学报（医学版）》
CAS
2021年第1期70-75,共6页
Journal of Lanzhou University（Medical Sciences）
基金
甘肃省卫生行业科研计划项目(GSWSKY-2015-43)。
